Breath of Life: Reduction in Neonatal Mortality in Vietnam through the Deployment of Continuous Positive Airway Pressure (CPAP) for Respiratory Care

6.1.2010

SPEAKER:
Steven Ringer, MD, PHD, Chief, Division of Newborn Medicine, Brigham and Women’s Hospital

 

MODERATOR:
Nina Dudnik, PhD, Founder and CEO, Seeding Labs

 

 

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Forum Abstract

Neonatal respiratory distress is a major cause of morbidity and mortality in developing nations. In Vietnam, infants were regularly referred to central hospitals for care, but the limited equipment and difficult transports left many infants with inadequate care, and mortality from respiratory distress was 45% or greater at <24 hours. Steven Ringer's team had developed a locally made, low cost CPAP system and deployed it in a central hospital, decreasing early mortality there by 2/3.

The team hypothesized that widespread implementation would significantly reduce mortality and the need for transfer to central hospitals. The team expanded CPAP distribution and extensive training to 20 provincial and district hospitals in 2005 through the Breath of Life Program of East Meets West Foundation. The program was progressively expanded to a total of 112 hospitals and 405 total machines. Hospitals were invited to apply for participation, sites and the number of machines allotted was determined on the basis of need and the neonatal population served. Full deployment was achieved in 8/09; no other hospitals are requesting participation in the program. Data were collected on number of infants treated, diagnoses, mortality and need for transfer to higher level care.

Machines have been lost to wear, and the number replaced was adjusted based on monitored needs. Currently there are 340 CPAP machines in daily use in 112 hospitals. Mortality in the first 24 hours has been reduced from 35-45% to 10-13%, and overall mortality in the first 28 days has been decreased from 25% to 5-7%. Transfer to central hospitals has decreased by 80%, but the number of infants transferred from district hospitals to CPAP equipped provincial hospitals has increased by 70-100%.

Using a distribution formula to maximize the number of hours used and babies treated by each machine per year, and an extensive training program for caregivers, low cost locally-made CPAP has been successfully implemented across 112 hospitals throughout the provinces of Vietnam, saving approximately 7000 lives annually. Care in provincial hospitals has been enhanced, and the number of infants able to get care and survive has increased. Transfer to central hospitals has been dramatically reduced, reducing the burden on these hospitals, and many of those now transferred from District Hospitals are babies who previously would have expired for lack of available care.

(Steven A Ringer, MD PhD, Priscilla Joe, MD and Luciano Moccia. Newborn Medicine, Brigham and Womens Hospital, Boston, MA,; Neonatology, Oakland Childrens Hospital, Oakland, CA, United States and East Meets West Foundation, Hanoi, Viet Nam)

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